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Clindamycin

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Clindamycin, Cleocin, Lincosamide Antibiotic

  • See Also
  1. Anti-Ribosomal Antibiotic
  2. Clindamycin Topical
  • Indications
  1. Activity spectrum
    1. Gram Positive Bacteria
      1. Includes MRSA (but growing resistance, including induced resistance)
      2. D-Test can evaluate for MRSA inducible resistance
    2. Anaerobic Bacteria infection
    3. No activity against Gram Negative Bacteria
  2. Conditions (FDA approved)
    1. Intraabdominal infections (must be combined with Gram Negative coverage, e.g. Aminoglycosides)
      1. Peritonitis
      2. Pelvic Inflammatory Disease
    2. Skin and Soft Tissue Infections
    3. MRSA Pneumonia
    4. MRSA Osteomyelitis
    5. SBE Prophylaxis
  3. Conditions (off-label)
    1. See Clindamycin Topical
    2. Orofacial infections
    3. Bacterial Vaginosis
    4. Necrotizing Fasciitis or Toxic Shock Syndrome (as part of multi-drug regimen)
    5. Streptococcal Pharyngitis (in Penicillin allergic patients)
    6. Malaria
    7. Anthrax
    8. Babesiosis
  • Mechanism
  1. Lincosamide Antibiotic
    1. Derivative of lincomycin, originally isolated from soil actinomycete Streptomyces lincolnensis
  2. Anti-Ribosomal Antibiotic
    1. Binds 50S subunit of Bacterial ribosomes preventing peptidyl-tRNA translocation from A site to P site
    2. Results in incomplete Bacterial Protein chains
  1. See Clindamycin Topical
  2. Take capsules with water to prevent esophageal irritation
  3. May take with or without food
  4. Reduce dose in hepatic dysfunction
  • Dosing
  • Adult
  1. Oral
    1. Moderate infections: 300 to 450 mg orally three to four times daily
    2. Severe or complicated infections: 600 mg orally three times daily
  2. IV: 600 to 900 mg IV every 8 hours
  3. IM: up to 600 mg every 8 hours
  • Dosing
  • Child
  1. Preterm Infant
    1. IV: 15 mg/kg/day IV divided three times daily
  2. Term Infants < 1 month
    1. IV: 15 to 20 mg/kg/day IV divided three times daily
  3. Child
    1. IV: 20 to 40 mg/kg/day IV divided every 6 to 8 hours
    2. PO: 8 to 20 mg/kg/day orally divided three to four times daily
  • Pharmacokinetics
  1. Both renal and hepatic excretion
  2. Actively transported into abscesses
  3. Does not enter cerebrospinal fluid
  • Adverse Effects
  1. Abdominal cramping
  2. Diarrhea
  3. Pseudomembranous colitis (Clostridioides difficile)
    1. Although most systemic Antibiotics risk C. diff, Clindamycin has been most associated historically
  • Safety
  1. Considered safe in pregnancy
  2. Considered safe in Lactation
  • Drug Interactions
  1. CYP3A4 Inducers
    1. Decrease Clindamycin serum levels
  • Resources
  1. Clindamycin Phosphate Injection (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=57c52462-fe8f-4202-ac30-3bd77f8d603f
  2. Clindamycin Hydrochloride Capsule (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=3f6b2c5a-e581-414f-bc9e-eaf66a5685cd